1
Federal-State Response to the Opioid Crisis
Session 48
February 12, 2019
2
• Thomas Novak, Medicaid Interoperability Lead, Office Of The
National Coordinator / CMS
• Shereef Elnahal, MD, MBA, New Jersey Health Commissioner
• Wesley Sargent, Jr, EdD, MA, Centers for Disease Control and
Prevention
• Melissa Lauer, MPA, Health Information Technology Specialist,
Rhode Island Executive Office of Health and Human Services
– Has no real or apparent conflicts of interest to report.
– The findings and conclusions are those of the presenter and
do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
Conflict of Interest
• June 11, 2018: “Leveraging Medicaid Technology to Address the Opioid Crisis”
(SMD 18-006)
– https://www.medicaid.gov/federal-policy-guidance/downloads/smd18006.pdf
• Section 5042 of the SUPPORT Act – The PARTNERSHIP Act: “Medicaid Providers
Are Required To Note Experiences in Record Systems to Help In-need Patients
Act”
Leveraging Medicaid Technology to Address the Opioid Crisis
thomas.novak@hhs.gov
• PDMP/EHR integration
• Predictive Analytics for case
management
• Substance Use Disorder
related CDS tools
• Medication Assisted Therapy
(MAT), including via
telehealth
• Linkages to other non-
controlled RX data & other
data (drug court, care teams,
etc.)
• E-prescribing of controlled
substances (ePCS)
• Public Health Tools
• Telemedicine & telepsychiatry
• Case management & care plans for
Neonatal Abstinence Syndrome
• Patient-facing technology including
apps
• Shared electronic care plans
4
Data Sources
Office of
Emergency
Medical
Services
New Jersey
State Police
Office of the Chief
State Medical
Examiner (OSME)
Division of
Mental Health
and Addiction
Services
Division of
Consumer
Affairs
Healthcare
Quality and
Informatics
Communicable
Disease
Service
U.S. Census
Bureau
Division of HIV,
STD and TB
Services
Drug-related Deaths
Crime Statistics
Treatment Statistics
Prescription Monitoring
Program
Naloxone (Narcan®)
Drug-related Hospital
Visits
Current Opioid Dashboard
6
Using NJHIN for Clinical EHR data,
surveillance
1) Daily collection of
a) Demographic Data
b) Rx Data (PMP/SureScripts)
c) Claims Data
d) HIO/Hospital EMR data/SUD
providers
Maintain Risk table linked to NJHIN MPI
2) Every Patient Admitted in ED generates
an ADT alert to NJHIN
NJHIN send back a Patient Risk Score in
real time.
3) Based on elevated Risk Factor
patient will:
- be considered for ALTO guidelines
- receive education and information
- referred for f/u pain management
7
Future State: Enhanced Opioid
Dashboard
Essex County: Demand
• Drug-related deaths: 271
• Drug-death rate (per 100,000):
33.9
• Naloxone Incidents: 739
• Rate of substance use
admissions (per 100,000):
1,091
• Number of first time
admissions: 8,773
• Drug-related hospital visits
(rate per 100, 000): 101.5
• Opioid prescription rate (per
100): 44.8
• Arrests (possession/use): 4,937
• Arrests
(sale/manufacture):1684
Essex County: Supply
• Inpatient treatment capacity
(available beds)
• Ambulatory treatment capacity
(SUD clinics, AWD services,
etc.)
• Primary care/family medicine
provider slots (Outpatient-
Based Addiction Treatment, OR
OBAT)
• Emergency rooms with
suboxone induction
• Peer recovery specialist supply
• Syringe access program
capacity
• ALTO-trained emergency
rooms
• ALTO-trained providers
Smarter Policy
Decisions:
• SUD/integrated
license prioritization
by region
• Targeted OBAT
training to providers
• Targeted
deployment of
opioid alternative
training to providers
• New syringe access
program locations
• Targeted
deployment of ALTO
training
* All data is 2016 data, with exception of Nalaxone incidents, which is 2017 data.
9
Rise in Opioid
Deaths
Overlapping, Entangled
but Distinct Epidemics
10
Preventing Opioid Overdoses and
Opioid-Related Harms
Conduct surveillance
and research
Empower
consumers to make
safe choices
Build state, local,
and
tribal capacity
Support providers,
health systems,
and payers
Partner with
public safety
11
CDC Resources
CDC Opioid Overdose Prevention Website
www.cdc.gov/drugoverdose
State Efforts
https://www.cdc.gov/drugoverdose/states/index.html
CDC Guideline for Prescribing Opioids for Chronic Pain
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Resources for Patients
https://www.cdc.gov/drugoverdose/patients/index.html
Resources for Providers
https://www.cdc.gov/drugoverdose/providers/index.html
Clinical Decision Support Resources
• Implementation Guide Output
http://build.fhir.org/ig/cqframework/opioid-cds/
• Source for the implementation guide
https://github.com/cqframework/opioid-cds
• Supporting Java packages for the CQL-to-ELM translator and CQL Engine
https://github.com/cqframework/opioid-cds-logic
12
Contact: Wes Sargent
Wsargent@cdc.gov
Please note that the findings
and conclusions in this report
are those of the authors and do
not necessarily represent the
official position of the Centers
for Disease Control and
Prevention.
13
• Background: Rhode Island Context
• RI’s HIE Enabled Overdose Prevention Project
– Components
– Funding
– Details on three of the five components
• Planned next steps
Agenda
14
• Identify creative ways for states to leverage Medicaid Federal
Financial Participation (FFP) to address the opioid crisis
• Consider three technical approaches to getting important opioid-
related data in front of providers
• Learn how RI plans to continue additional opioid-related HIT work
Learning Objectives
15
The Opioid Crisis in Rhode Island
From 2011 to 2016, overdose deaths nearly doubled
Source: RI Department of Health
16
Governor Gina Raimondo’s Overdose Prevention and Intervention
Task Force proposed 4 strategies to reduce overdose deaths
• Prevention: Take aggressive measures to improve patient
safety and better monitor opioid use through the PDMP
• Rescue: Ensure access to naloxone
• Treatment: Expand the quality and availability of
medication-assisted treatment
• Recovery: Expand access to peer-recovery services and
MAT
More detailed data and information is available at
https://preventoverdoseri.org
RI Strategies to Reduce Overdose Deaths
17
RI has a state designated entity for Health Information
Exchange: Rhode Island Quality Institute (RIQI)
They operate the HIE which was launched in 2010:
• RI’s HIE is currently opt-in for collecting and sharing data.
• About 50% of Rhode Islanders have opted-in
• RIQI also provides full-panel services under BAAs
RI’s Health Information Exchange
18
RI Medicaid partnered with the Rhode Island Foundation to
develop five components using CurrentCare
• PDMP-EHR Integrations
• Intelligent Overdose Alert
• Emergency Department Smart Notifications
• Emergency Medical Services Integration
• SBIRT Screening Platform (Public Health Registry)
HIE-Enabled Opioid Overdose Prevention
Project
Talking
about
today
19
• SMD #16-003 increased the activities with non-Eligible
Professionals (non-EPs) that could be supported with
HITECH dollars
• We requested 90/10 funding under the Medicaid
HITECH I-APD to support these five efforts
• RI’s mainstreaming clause = 100% Medicaid cost
allocation
• This requires that any MCOs that have commercial
networks much include those providers in their Medicaid
networks
Funding these projects
20
Benefits:
• Reduces the time to check the PDMP from 3-5 minutes to only 5 seconds
• Ensures compliance with state law/regulations by making it impossible to
prescribe an opioid without checking the PDMP
PDMP-EHR Integrations
Provider queries PDMP in
one of two ways:
• Starts to prescribe an
opioid
• Clicks a PDMP button
Prescription Drug
Monitoring Program
Appriss, Inc.,
PMP Gateway
NABP PMP
Interconnect for
other state data
NCPDP Script 10.6 or SMART on FHIR
21
Intelligent Overdose Alert
Benefits:
• Makes it easy to find overdose-related ADTs in a crowded alert inbox
Adds a *POTENTIAL OVERDOSE* flag to the subject and
body of existing ADT Direct message alerts if relevant
reason for visit or diagnosis is present
22
Emergency Department Smart Notifications
Benefits:
• Provides high-value, actionable information that may not already exist in the
EHR to the ED providers within the workflow
Patient Registers at
Emergency Department
ADT Registration
Prescription Drug
Monitoring Program
RIQI
Analytics
Environment
ADTs from all
Rhode Island
Hospitals
Clinical data from
HIE repository
If risk is identified,
Notification and detailed
content displays in patient
tracker board
Risk algorithm looks for:
• Any ED admissions in last 7 or 30
days
• Risk of Opioid Use Disorder or Opioid
Overdose based on 7 factors
23
SUD/OUD Waiver: Leverage the work already underway
to support the requirements of the Health IT Plan under
the Medicaid 1115 SUD/OUD Waiver (SMD #17-003)
Section 5042 of the SUPPORT Act: Continue to expand
these efforts (additional integrations, additional features,
PDMP enhancement, etc.) where justifiable with 100%
FFP under this new law
Continue to leverage HITECH dollars and transition
to MMIS funding: Continue to roll out other efforts at
90/10 under HITECH or MMIS where applicable, and
transition efforts into RI’s MITA
Planned Next Steps
